Analysis of comorbidities and multimorbidity in adult patients in the International Severe Asthma Registry

Ghislaine Scelo, Carlos A. Torres-Duque, Jorge Maspero, Trung N. Tran, Ruth Murray, Neil Martin, Andrew N. Menzies-Gow, Mark Hew, Matthew J. Peters, Peter G. Gibson, George C. Christoff, Todor A. Popov, Andréanne Côté, Celine Bergeron, Delbert Dorscheid, J. Mark FitzGerald, Kenneth R. Chapman, Louis Philippe Boulet, Mohit Bhutani, Mohsen SadatsafaviLibardo Jiménez-Maldonado, Mauricio Duran-Silva, Bellanid Rodriguez, Carlos Andres Celis-Preciado, Diana Jimena Cano-Rosales, Ivan Solarte, Maria Jose Fernandez-Sanchez, Patricia Parada-Tovar, Anna von Bülow, Anne Sofie Bjerrum, Charlotte S. Ulrik, Karin Dahl Assing, Linda Makowska Rasmussen, Susanne Hansen, Alan Altraja, Arnaud Bourdin, Camille Taille, Jeremy Charriot, Nicolas Roche, Andriana I. Papaioannou, Konstantinos Kostikas, Nikolaos G. Papadopoulos, Sundeep Salvi, Deirdre Long, Patrick D. Mitchell, Richard Costello, Concetta Sirena, Cristina Cardini, Enrico Heffler, Francesca Puggioni, Giorgio Walter Canonica, Giuseppe Guida, Takashi Iwanaga, Mona Al-Ahmad, Désirée Larenas Linnemann, Ulises Garcia, Piotr Kuna, João A. Fonseca, Riyad Al-Lehebi, Mariko Siyue Koh, Chin Kook Rhee, Borja G. Cosio, Luis Perez de Llano, Diahn Warng Perng (Steve), Erick Wan Chun Huang, Hao Chien Wang, Ming Ju Tsai, Bassam Mahboub, Laila Ibraheem Jaber Salameh, David Jackson, John Busby, Liam G. Heaney, Paul Pfeffer, Amanda Grippen Goddard, Eileen Wang, Flavia Hoyte, Michael E. Wechsler, Nicholas Chapman, Rohit Katial, Victoria Carter, Lakmini Bulathsinhala, Neva Eleangovan, Con Ariti, Juntao Lyu, David B. Price, Celeste Porsbjerg

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


BACKGROUND: Investigation for the presence of asthma comorbidities is recommended by the Global Initiative for Asthma because their presence can complicate asthma management.

OBJECTIVE: To understand the prevalence and pattern of comorbidities and multimorbidity in adults with severe asthma and their association with asthma-related outcomes.

METHODS: This was a cross-sectional study using data from the International Severe Asthma Registry from 22 countries. A total of 30 comorbidities were identified and categorized a priori as any of the following: (1) potentially type 2-related comorbidities, (2) potentially oral corticosteroid (OCS)-related comorbidities, or (3) comorbidities mimicking or aggravating asthma. The association between comorbidities and asthma-related outcomes was investigated using multivariable models adjusted for country, age at enrollment, and sex (ie male or female).

RESULTS: Of the 11,821 patients, 69%, 67%, and 55% had at least 1 potentially type 2-related, potentially OCS-related, or mimicking or aggravating comorbidities, respectively; 57% had 3 or more comorbidities, and 33% had comorbidities in all 3 categories. Patients with allergic rhinitis, nasal polyposis, and chronic rhinosinusitis experienced 1.12 (P = .003), 1.16 (P < .001), and 1.29 times (P < .001) more exacerbations per year, respectively, than those without. Patients with nasal polyposis and chronic rhinosinusitis were 40% and 46% more likely (P < .001), respectively, to have received long-term (LT) OCS. All assessed potential OCS-related comorbidities (except obesity) were associated with a greater likelihood of LTOCS use (odds ratios [ORs]: 1.23-2.77) and, except for dyslipidemia, with a greater likelihood of uncontrolled asthma (ORs: 1.29-1.68). All mimicking or aggravating comorbidities assessed were associated with more exacerbations (1.24-1.68 times more), all (except bronchiectasis) with increased likelihood of uncontrolled asthma (ORs: 1.57-1.81), and all (except chronic obstructive pulmonary disease) with increased likelihood of LTOCS use (ORs: 1.37-1.57). A greater number of comorbidities was associated with worse outcomes.

CONCLUSION: In a global study, comorbidity or multimorbidity is reported in most adults with severe asthma and is associated with poorer asthma-related outcomes.

CLINICAL TRIAL REGISTRATION: The International Severe Asthma Registry database has ethical approval from the Anonymous Data Ethics Protocols and Transparency (ADEPT) committee (ADEPT0218) and is registered with the European Union Electronic Register of Post-Authorization Studies (European Network Centres for Pharmacoepidemiology and Pharmacovigilance [ENCEPP]/DSPP/23720). The study was designed, implemented, and reported in compliance with the European Network Centres for Pharmacoepidemiology and Pharmacovigilance (ENCEPP) Code of Conduct (EMA 2014; EUPAS44024) and with all applicable local and international laws and regulations, and registered with ENCEPP ( Governance was provided by ADEPT (registration number: ADEPT1121).

Original languageEnglish
Pages (from-to)42-53
Number of pages12
JournalAnnals of Allergy, Asthma and Immunology
Issue number1
Early online date26 Aug 2023
StatePublished - Jan 2024


Dive into the research topics of 'Analysis of comorbidities and multimorbidity in adult patients in the International Severe Asthma Registry'. Together they form a unique fingerprint.

Cite this